Department of Liver Transplant and Hepato-Pancreato-Biliary Surgery, Institute of Liver and Biliary Sciences, New Delhi, India.
Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.
Liver Transpl. 2019 Sep;25(9):1408-1421. doi: 10.1002/lt.25445. Epub 2019 Jul 29.
In countries where deceased organ donation is sparse, emergency living donor liver transplantation (LDLT) is the only lifesaving option in select patients with acute liver failure (ALF). The aim of the current study is living liver donor safety and recipient outcomes following LDLT for ALF. A total of 410 patients underwent LDLT between March 2011 and February 2018, out of which 61 (14.9%) were for ALF. All satisfied the King's College criteria (KCC). Median admission to transplant time was 48 hours (range, 24-80.5 hours), and median living donor evaluation time was 18 hours (14-20 hours). Median Model for End-Stage Liver Disease score was 37 (32-40) with more than two-thirds having grade 3 or 4 encephalopathy and 70% being on mechanical ventilation. The most common etiology was viral (37%). Median jaundice-to-encephalopathy time was 15 (9-29) days. Preoperative culture was positive in 47.5%. There was no difference in the complication rate among emergency and elective living liver donors (13.1% versus 21.2%; P = 0.19). There was no donor mortality. For patients who met the KCC but did not undergo LT, survival was 22.8% (29/127). The 5-year post-LT actuarial survival was 65.57% with a median follow-up of 35 months. On multivariate analysis, postoperative worsening of cerebral edema (CE; hazard ratio [HR], 2.53; 95% confidence interval [CI], 1.01-6.31), systemic inflammatory response syndrome (SIRS; HR, 16.7; 95% CI, 2.05-136.7), preoperative culture positivity (HR, 6.54; 95% CI, 2.24-19.07), and a longer anhepatic phase duration (HR, 1.01; 95% CI, 1.00-1.02) predicted poor outcomes. In conclusion, emergency LDLT is lifesaving in selected patients with ALF. Outcomes of emergency living liver donation were comparable to that of elective donors. Postoperative worsening of CE, preoperative SIRS, and sepsis predicted outcome after LDLT for ALF.
在器官捐献率较低的国家，在某些急性肝衰竭（ALF）患者中，紧急活体供肝肝移植（LDLT）是唯一的救命选择。本研究旨在评估 LDLT 治疗 ALF 的活体供肝安全性和受者结局。2011 年 3 月至 2018 年 2 月期间，共有 410 例患者接受 LDLT，其中 61 例（14.9%）为 ALF。所有患者均符合 King's College 标准（KCC）。中位移植入院时间为 48 小时（范围：24-80.5 小时），中位活体供者评估时间为 18 小时（14-20 小时）。中位终末期肝病模型评分 37 分（32-40 分），超过三分之二的患者存在 3 级或 4 级肝性脑病，70%的患者接受机械通气。最常见的病因是病毒（37%）。中位黄疸至脑病时间为 15 天（9-29 天）。术前培养阳性率为 47.5%。急诊和择期活体供肝供者的并发症发生率无差异（13.1%比 21.2%；P=0.19）。无供者死亡。对于符合 KCC 但未行 LT 的患者，生存率为 22.8%（29/127）。LT 后 5 年的累积生存率为 65.57%，中位随访时间为 35 个月。多因素分析显示，术后脑水肿（CE）恶化（风险比 [HR]，2.53；95%置信区间 [CI]，1.01-6.31）、全身炎症反应综合征（SIRS；HR，16.7；95%CI，2.05-136.7）、术前培养阳性（HR，6.54；95%CI，2.24-19.07）和无肝期延长（HR，1.01；95%CI，1.00-1.02）与不良结局相关。总之，对于急性肝衰竭的某些患者，紧急 LDLT 是救命的。急诊活体供肝的结局与择期供者相似。术后 CE 恶化、术前 SIRS 和脓毒症预测了 LDLT 治疗 ALF 的结局。
